| NPI | 1982016176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 61527) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 582WW1773) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2020-07-22 |